Cypress Certification Patient Test Record: Natalie Fernandez

Patient
Natalie Fernandez
Sex
F - Female
Date of birth
1996-06-05 15:30:00 UTC
Date of expiration
None
Race
1002-5 - American Indian or Alaska Native
Ethnicity
2186-5 - Not Hispanic or Latino
Insurance Providers
349 - Other
Patient IDs
600b34266362390374dc33be Cypress
Address
12395 Baumbach Springs Brooks
Port Vivien, IA 51019
US
Telecom
(HP) 223.114.8644

QDM::AllergyIntolerance

Description
Codes
Time
Fields/Results
Influenza Vaccination
Codes:
SNOMEDCT: 86198006 - Influenza vaccination (procedure)
CPT: 90630 - Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use
HCPCS: G0008 - Administration of influenza virus vaccine
Time Elements:
Prevalence Period Start: 2021-04-11T08:00:00.000Z
Other Fields:
Influenza Vaccine
Codes:
CVX: 135 - influenza, high dose seasonal, preservative-free
Time Elements:
Prevalence Period Start: 2021-04-11T08:00:00.000Z
Other Fields:

QDM::Diagnosis

Description
Codes
Time
Fields/Results
Intolerance to Influenza Vaccine
Codes:
SNOMEDCT: 420113004 - Influenza virus vaccine adverse reaction (disorder)
Time Elements:
Prevalence Period Start: 2021-04-11T08:00:00.000Z
Other Fields:

QDM::EncounterPerformed

Description
Codes
Time
Fields/Results
Office Visit
Codes:
CPT: 99203 - Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family.
Time Elements:
Relevant Period Start: 2021-03-07T08:00:00.000Z
Relevant Period End: 2021-03-07T08:30:00.000Z
Other Fields:
Length Of Stay: 0 d
Encounter-Influenza
Codes:
CPT: 99341 - Home visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Typically, 20 minutes are spent face-to-face with the patient and/or family.
Time Elements:
Relevant Period Start: 2021-04-11T08:00:00.000Z
Relevant Period End: 2021-04-11T08:30:00.000Z
Other Fields:
Length Of Stay: 0 d

QDM::ProcedurePerformed

Description
Codes
Time
Fields/Results
Influenza Vaccination
Codes:
NA_VALUESET: 2.16.840.1.113883.3.526.3.402 - Influenza Vaccination
Time Elements:
Relevant Date/Time: 2021-03-07T08:15:00.000+00:00
Author Date/Time: 2021-03-07T08:15:00.000+00:00
Other Fields:
Negation Reason: 293112000 (SNOMEDCT) - Influenza split virion vaccine adverse reaction (disorder)
Rank: 1

QDM::PatientCharacteristicPayer

Description
Codes
Time
Fields/Results
Codes:
Source of Payment Typology: 349 - Other
Time Elements:
Relevant Period Start: 2020-10-21T08:15:00.000Z
Other Fields:

QDM::PatientCharacteristicBirthdate

Description
Codes
Time
Fields/Results
Codes:
LOINC: 21112-8 - Birth date
Time Elements:
Birth Date/Time: 1996-06-05T15:30:00.000+00:00
Other Fields:

QDM::PatientCharacteristicSex

Description
Codes
Time
Fields/Results
Codes:
AdministrativeGender: F - Female
Time Elements:
Other Fields:

QDM::PatientCharacteristicRace

Description
Codes
Time
Fields/Results
Codes:
CDCREC: 1002-5 - American Indian or Alaska Native
Time Elements:
Other Fields:

QDM::PatientCharacteristicEthnicity

Description
Codes
Time
Fields/Results
Codes:
CDCREC: 2186-5 - Not Hispanic or Latino
Time Elements:
Other Fields: